Autoimmune pancreatitis (diagnostic criteria)
There are several sets of diagnostic criteria for autoimmune pancreatitis (AIP), with some overlap and contradictions.
At the time of writing (July 2016), these are the most widely used sets of diagnostic criteria.
Asian 2008 AIP diagnostic criteria
- both criteria I to be fulfilled
- one criterion II
- consistent histology
The criteria are 1:
criteria I: imaging
- enlargement of the gland (may be diffuse/segmental/focal) +/- hypo-attenuating rim (halo)
- pancreatic duct narrowing (may be diffuse/segmental/focal) +/- stenosis of the common bile duct
criteria II: serology
- elevated serum IgG or IgG4
- detectable autoantibodies (ANA, RF)
criteria III: histopathology
- lymphoplasmacytic infiltration (IgG4 positive) with fibrosis
Mayo Clinic HISORt criteria (2007)
AIP should be suspected in patients with obstructive jaundice, pancreatic mass/enlargement, or pancreatitis, AND one or more of five cardinal features of AIP in 2:
- other organ involvement
- response to steroid therapy
Summarized in the mnemonic HISORt.
Typical histological features include lymphoplasmacytic infiltrate, storiform fibrosis (elevated IgG4), and obliterative phlebitis.
Classical imaging features of AIP.
Unlike the Asian criteria, the Mayo Clinic criteria take account of possible other organ involvement accompanying AIP in the setting of IgG4-related sclerosing disease, and also of the response to steroid therapy following which normalization of imaging and histological findings is expected.
International Consensus Diagnostic Criteria (ICDC) for AIP
In 2010, during the 14th Congress of the International Association of Pancreatology, criteria were proposed as a consensus of the working group 3. These are the same as the five Mayo Clinic 2 features as listed above with response to steroids being optional. Levels 1 and 2 have been introduced based on the diagnostic reliability of each feature. For example, if IgG4 elevation is more than 2, it is considered level 1 and if it is less than 2, it is considered level 2.
- 1. Otsuki Makoto. “Asian diagnostic criteria for autoimmune pancreatitis: consensus of the Japan-Korea Symposium on Autoimmune Pancreatitis.” Journal of Gastroenterology 43, no. 6 (January 1, 2008): 408. [Link].
- 2. Chari ST. Diagnosis of autoimmune pancreatitis using its five cardinal features: introducing the Mayo Clinic's HISORt criteria. J. Gastroenterol. 2007;42 Suppl 18 (18): 39-41. J. Gastroenterol. (abstract) - doi:10.1007/s00535-007-2046-8 - Pubmed citation
- 3. Shimosegawa T, Chari ST, Frulloni L et-al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas. 2011;40 (3): 352-8. doi:10.1097/MPA.0b013e3182142fd2 - Pubmed citation